A common and somewhat unique aspect to EHR vendor contracts is that the EHR vendor lays claim to the data entered into their system. Rob and I have worked in many industries as analysts. Nowhere, in our collective experience, have we seen such a thing. Manufacturers, retailers, financial institutions, etc. would never think of relinquishing their data to their enterprise software vendor of choice.

It confounds us as to why healthcare organizations let their vendors of choice get away with this and frankly, in this day of increasing concerns about patient privacy, why is this practice allowed in the first place?

The ONC recommendations are good but incomplete and come from a legal perspective.

As we approach the 3-5 year anniversary of the beginning of the upsurge in EHR purchasing via the HITECH Act, cracks are beginning to show. Roughly a third of healthcare organizations are now looking to replace their EHR. To assist HCO clients we wrote an article published in our recent October Monthly Update for CAS clients expanding on some of the points made by the ONC, and adding a few more critical considerations for HCOs trying to lower EHR costs and reduce risk.

The one item in many EHR contracts that is most troubling is the notion the patient data HCOs enter into their EHR is becomes the property in whole, or in-part, of the EHR vendor.

It’s Your Data — Act Like it Prior to the internet-age the concept that any data input into software either on the desktop, on-premise or in the cloud (AKA hosted or time sharing) was not owned entirely by the users was unheard of. But with the emergence of search engines and social media, the rights to data have slowly eroded away from the user in favor of the software/service provider. Facebook is notorious for making subtle changes to its data privacy agreements that raise the ire of privacy rights advocates.

Of course this is not a good situation when we are talking about healthcare, a sector that collects the most personal data one may own. EHR purchasers need to take a hard detailed look at their software agreements to get a clear picture of what rights to data are being transferred to the software vendors and whether or not that is in the best interests of the HCO and the community it serves..

Our recommendation: Do not let EHR vendor have any rights to the data – Period!

The second data ownership challenge to be very careful of is the increasing incorporation of patient generated health data into the healthcare delivery system. We project an explosion in the use of biometric devices, be it consumer purchased or HCO supplied, to monitor the health of patients outside of the exam room. Much of this data will find its way into the EHR. Exactly who owns this data and what rights each party has is still debatable. It is critical that before HCOs accept user data they work out user data ownership processes, procedures, and rights.

If the EHR vendor has retained some rights to data the patients need to be informed and have consented to this sharing agreement. In our experience this is rarely if ever explicitly stated. HCOs need to be careful here as this could become a public relations disaster.

We are not lawyers, we are offering our advice and experience to HCO CEOs, CFOs and CIOs, from the perspective of business risk and economics. At Chilmark we have deep experience in best practices used in other industries with regards to data use and sharing agreements. We have also spent significant time reviewing the entire software purchasing lifecycle and culture, and are here to help HCOs in reviewing these contracts.

November 14, 2013
Like many other industries, healthcare is becoming more consumer-focused. As Eric Wicklund and Mike Miliard have recently documented for Healthcare IT News, patients and doctors alike have spoken out against EHR solutions for interfering with rather than facilitating doctor-patient interactions. While thorough data collection and analysis, where EHRs offer great value, feeds research at the population level, it seems that the apparent failure of current EHRs to accommodate patients as unique cases has sparked this shift in attitude in the health IT industry.

[See also: Docs ‘stressed and unhappy’ about EHRs.] and [EHRs at risk of becoming irrelevant.]
The issue may not be so much the failure of EHRs, as their falling short of unduly high expectations — expectations not only from the people who use them, but also the vendors themselves.
“I think it’s a myth that EHR vendors are going to be able to provide everything. Every other industry has proven this wrong, says Joanne Rohde, CEO of Axial Exchange, in an interview with Healthcare IT News.

Rohde, an exponent of open source philosophy — she was the COO and director of Health IT strategy at Red Hat prior to Axial — contrasted open source design with EHR vendors’ current design approach, suggesting that large, branded EHR vendors have made the mistake of dictating users’ workflow rather than providing them with software that actually complements how they normally work.
“There’s no question that modular design, open source practices, iterative design would do a much better job in ending up with things that people want to use…[Epic’s] approach is exactly the opposite, and their approach is that we’re going to tell you how this works, you have to change your workflows to match our system, and then and only then are you going to get benefits from this system”
This domineering EHR design approach, while perhaps expedient for expanding a company’s market share, could backfire with the progressive consumerization of healthcare IT. The question, then, is how to begin to amend this approach in light of this trend.
“I think the [EHR vendors] that will be successful,” said Rohde, “are going to be the ones that don’t try to hold on to what they have, look at it with a clean slate, and say ‘alright, we need to engage the patient; how do we do that?’ and then secondarily ask ‘how does this integrate with the software we already have?’”
More and more, healthcare professionals are talking about patient engagement, though it can be difficult, as with all buzz words, to parse what that means in practical terms. mHealth has grown extremely popular as a patient-centric, healthcare model, and Axial Exchange, billing itself as patient engagement software, has successfully deployed mobile applications for Parrish Medical Center in Florida, the Colorado Medical Group, and several others, following a patient-centric design strategy that offers a health information library, along with numerous health trackers for blood glucose, migraines, pregnancy, and even mood. In other words, letting patients learn about themselves, to engage in their own care.
Patient engagement, as the phrase’s ambiguous grammar suggests, goes both ways. HIT solutions, like Axial’s, allow the patients to learn about and monitor their care so that they can bring more actionable information, and not just numbers or vague descriptions of their issues to physician visits. But, as Rohde said, Axial is “committed to not only the patients knowing themselves, but the hospitals knowing their patients.” Axial has also complemented its mHealth work with a provider-side tool for engaging patients, a blind analytics service that allows hospitals to see what health issues their patients are researching.

Managing Unsolicited Health Information in the Electronic Health Record

Patient engagement is developing as a key focus area in US healthcare, and patients are increasingly able—and willing—to report additional health information to their providers. Historically, healthcare providers have received unsolicited patient health information, including health data volunteered by the patient or other providers responsible for patient care. In its most simple form, unrequested information is data received by a healthcare provider who has taken no active steps to ask for or collect that information. In some instances, this information is provided in the absence of an existing patient-physician relationship. For example, consider a patient who has recently moved to a new location. Though the individual may have already picked a primary care physian for insurance puposes, if they are seen in an emergency room prior to established contact they may still wish to send the information from their visit to the primary provider.

Today, unsolicited health information may come from many sources, such as health information exchanges (HIEs), personal health records (PHRs), or patient-generated health information from mobile devices. This unsolicited data can arrive in a variety of formats from paper to electronic media. As a result, healthcare providers are receiving more unsolicited information than ever before, the influx of which necessitates new methods to handle and process the data in an effective manner.

Some specialty physicians believe they have an obligation to send the patient’s primary care providers copies of the documentation for all encounters and treatment notes. The assumption is that all healthcare providers who treat the patient later will benefit from these records of historical care, even if the treatment does not relate to the current medical condition. Likewise, the patient may believe the information collected through a mobile health application is valuable and want the information included in the health record.

In the past, unsolicited health information that corresponded to existing patients was often filed in the paper record under a generic “correspondence” tab. Likewise, information that was received but that did not correspond to an existing patient was often placed in a file that would then be periodically reviewed to determine if the patient had followed up to establish a relationship with the provider. After a time period predetermined by the provider’s retention policy, if the patient does not present for care then the health information is destroyed.

When unsolicited health information is received, providers will need to address the receipt of the information, workflow challenges, and liability issues to ensure the information is handled effectively. This practice brief addresses the primary challenges in receiving unsolicited health information, followed by key recommendations to help manage it.

Unsolicited Records’ Primary Challenges

The information contained in a patient’s health record is used for a multitude of purposes, such as:

Treatment

Quality of care outcomes

Research

Fiscal responsibility

Risk management

Legal compliance

With electronic health records (EHRs) and other technological advances, the healthcare industry is moving toward achieving the goal of recording the entire continuum of patient care for treatment of the patient. Receiving health records that were not requested, however, brings up several challenges that providers must address, such as how to use, store, and determine the value of unsolicited health information.

Receiving Unsolicited Information

Integrating unsolicited information with a provider’s health record poses potential challenges for easily locating the information at a later date. Without notifying the receiving healthcare provider in advance, patients may request that all of their health information—including information that may not be relevant to their current care—be forwarded to an additional provider also involved in the patient’s care.

Patients may choose to do this in an effort to help the provider understand their unique medical circumstances, without being aware that the provider is unlikely to review all of the additional information received. Some of the content, including reports and test results, may be exact duplicates of information already available to the provider. Pertinent information helpful to the provider may arrive mixed in with volumes of non-essential information. Review of the variety and volume of the unsolicited information can be both a time consuming and costly process for the provider.

Managing the Media

The technological advances in EHRs, HIEs, e-mail, and mobile devices combined with the patient’s awareness and involvement in their healthcare all contribute to the myriad of media types in which providers receive unsolicited health information. Patients may e-mail health information or transmit electronic monitoring and test results to hospitals, physicians, and other providers. Patients also may store their personal health records on flash drives, compact discs, mobile applications, or paper files and want their providers to review all of this information during an office visit. Information received from multiple senders may contain duplicate, conflicting, or contradictory information. All of these challenges could result in errors in the record.

Health records on electronic media present additional challenges in a practice where the EHR system is not configured to receive or read from external devices. The patient may prefer their records be copied from the electronic media and have the device returned—a process that requires additional work and time. When interfacing with external devices, there is also a chance that the electronic media provided by the patient has a virus or other harmful program that will affect the provider’s system.

Workflow Challenges

Historically documents were routed to a specified location or individual in the provider’s office when unsolicited information arrived via paper charts. It was the responsibility of this individual, such as a file clerk or medical assistant, to match the information with a scheduled patient, categorize the incoming documents, and direct them to the provider for review. Once the appropriate provider(s) reviewed and/or notated the document, it was filed in the correct location in the patient chart. For example, there may be separate tabs for laboratory reports, imaging reports, and other correspondence or miscellaneous items. In addition, paper charts typically required a sign-out sheet so that all staff would know the location of the health record. Some providers had quality reviews routinely performed to ensure that all documents were in the correct patient chart and filed in the appropriate location.

The EHR can now allow records to be filed prior to the patient visit. Processes must be established to ensure the health records are filed to the correct patient and that the provider is notified that new information is available.

Confirming Provider-Patient Relationship

Providers face a significant challenge when it comes to a full review and analysis of all the unsolicited information they are likely to receive, particularly when there is not a prior established relationship with the patient. Providers might receive health information from patients who have been referred for specialty care but have not yet confirmed an appointment with the medical specialist. Specialists receive volumes of unsolicited information from primary care providers that may be non-essential for the specialist to make a treatment determination.

Regardless of the source or method of transfer, the provider should first determine the status of the provider’s relationship with the patient and whether there is an existing record. Using the identifiers contained in the information received, the provider should attempt to match the information with an existing patient record. If the patient does have an established relationship and record with the provider, processing can proceed to the next step.

In some cases, however, the patient may not have a record. For example, the patient may be planning to move to the area and is forwarding information to an office in which they plan to establish care. Or the patient has selected a provider within their health plan, but has not yet presented to the provider for evaluation.

When health information is received for a patient with no prior relationship or record with the provider, the provider must first determine if there is a policy in place that permits the retention of such information. If the provider policy permits retention of unsolicited information received with no prior record of relationship with the patient, regular intervals should be established to review the information and determine if the patient has followed up on establishing care with the provider. If the individual does present, then the information that is used for patient care should be included in the record. If the patient has not established a care relationship with the provider within the retention time period allowed in the provider’s policy, the information should be destroyed or returned to the sender.

Determining Pertinent Information

Once the patient relationship is confirmed, the next step is to determine if the unsolicited records will be incorporated, in whole or in part, into the provider’s official record of care. The patient may have requested that their entire record be forwarded, but the receiving healthcare organization may not need all the information to treat the patient. Some of the data received will require a certain level of medical knowledge to determine the value to the provider and subsequent care for the patient. For example, laboratory results from different laboratories may have different normal ranges, which can impact trending and comparing laboratory results in an EHR.

Some documents have succinct summaries of relevant information that supports the longitudinal record and clinical decisions. For example, if the unsolicited records contain a discharge summary, that document might be retained. Conversely, months of inpatient progress notes might not hold the same long-term clinical value. As a rule of thumb, always include any record that is used to make a decision about the diagnosis or treatment of the patient. Information that is not used to treat the patient should be destroyed or returned to the source of the information.

Integrating Health Information

Once health information has been identified as relevant and the decision made to retain it, the information must be integrated into the EHR. Protocols should be established to determine what will be included in the health record. The provider’s workflow should incorporate the review and processing of unsolicited records, and the protocol should include the provider’s approach to all types of media in order to ensure consistency when processing all unsolicited health information. The protocol should also include guidance on whether the unsolicited information will be entered into the record in chronological order or as a specific encounter. It’s important to incorporate unsolicited information in a way that ensures a clear differentiation between information received from external sources and similar types of information obtained internally. It may be necessary to revise the systems in order to make sure information can be both effectively integrated and subsequently retrieved.

Developing an Information Release Policy

If all unsolicited information is entered into the EHR, applicable law might create the presumption that the provider reviewed and utilized all of the information. Some state laws, for instance, might dictate this expectation. Unsolicited health information that is included in the legal health record may be disclosed pursuant to a patient request or external legal process. Providers should have a statement in the policy that unsolicited information included in the patient’s legal health record may be sent to other providers as authorized by the patient or for continuing care as determined by the provider. These policies should be communicated to patients when they provide unsolicited information.

Legal Considerations

Providers who receive unsolicited health information continue to wrestle possible clinical concerns. Any documents or information filed, maintained, or scanned into a patient’s health record—including external source documents—are part of the legal health record (see “Fundamentals of the Legal Health Record and Designated Record Set,” available in the HIM Body of Knowledge). These health records are subject to all applicable state and federal regulations concerning privacy, security, use, maintenance, and disclosure. Legal implications and liability issues must be considered when making retention decisions about unsolicited health information.

Retention Policies

Providers must determine if and how unsolicited health information will be retained and stored based on their definition of the legal health record. Each provider must identify what records are in their legal health record. Some data that arrives electronically may not be compatible with the provider’s EHR and could create inclusion, storage, and retrieval issues. If unsolicited health information is incorporated into the EHR, the provider will be responsible for knowing what it contains and its relevance to patient care. If the information is stored, providers must be sure it is indexed to the correct patient. This can be confusing and difficult if unique patient identifiers do not accompany the unsolicited information or if the individual has not yet been registered as a patient.

It is important to keep in mind throughout this process that providers have no obligation to accept unsolicited health records from outside sources. This does not mean that unsolicited health information is not desired or pertinent to patient care, only that the provider is not required to accept or retain it.

Liability Issues

Legal ramifications may occur if inadequate review of received unsolicited health information leads to ill-informed medical decisions or missed diagnoses. Providers that accept unsolicited information without completing a review may be held responsible for knowing the information is housed in their legal health record. In addition, there may not be legal precedents within that state to assist providers in establishing their policies and procedures regarding unsolicited health information. When developing a legal health record policy, providers should consult with healthcare regulatory counsel to address these liability concerns.

For example, the Texas Medical Association has adopted a practice guideline for providers to follow when individuals do not have an existing patient-provider relationship. The guideline states, “A physician might receive unsolicited medical test results on behalf of persons with whom they have not established a patient-physician relationship, who have [been] given the physician’s name in order to receive the medical screening test. In this event, physicians may return the results to the medical screening agency. In no event does receiving unsolicited medical screening test results alone establish a patient-physician relationship.”1 In accordance with this policy, the provider may be protected from liability if the unsolicited health information is returned to the agency that sent the result.

Recommendations and Best Practices

Identifying the challenges presented by unsolicited health information is easier than determining what actions should be taken with the information. Recommendations for managing unsolicited information include:

Develop policies with providers to determine:

Which unsolicited information will be retained routinely based on protocol (threshold for volume, type of report, specialty, and other established variables) and forwarded to the provider for review

The process for routing unsolicited information that falls outside of the protocol

The disposition of information that will not be retained based on clinical decisions

Develop policies for the administrative aspects of receiving and processing unsolicited information

Establish a definition of the legal health record

Determine how to manage e-mails/articles concerning health issues received from patients

Define guidelines for use of patients’ personal health records

Determine how health information maintained in various media formats will be managed

Review information received to:

Determine if a patient-provider relationship exists

Verify if it is required for treatment or if it is redundant, outdated, or non-essential

Determine how unsolicited information received for a patient not associated with the provider will be processed

Determine how the unsolicited information will be stored until a patient is identified or the information is destroyed

Establish a method to monitor if the individual has made an appointment within a defined period of time (i.e., within 60 days from the receipt of the unsolicited information)

Define time frames to destroy information that is not matched with an existing or scheduled patient

Develop protocols by specialty, clinical area, or document type for health information that may be accepted into the EHR and routed to the provider for review

Determine who will ensure pertinent external health information is routed to and reviewed by the provider when the EHR does not provide the ability to incorporate the information prior to the first appointment

Determine which healthcare provider will receive the health information that is outside of the established protocol and requires professional interpretation to determine what to retain

Define timeframes for a provider to review the unsolicited information

Develop standardized indexing protocols for filing information in the EHR to allow ease of retrieval

Utilize a non-networked computer for viewing or printing, or enable software to assist in preventing harmful information from being uploaded since external electronic media may have viruses or have other harmful effects on the computer or system

Provide education to all providers and staff on the steps that should be taken when they receive unsolicited health records, since health information can come into a practice in multiple places

As electronic technology progresses, some of the challenges with unsolicited health information will be addressed through technological advances. As providers gain more experience with managing unsolicited health information in an electronic environment, best practices will surface that will be helpful to providers.

“It has been a slow start,” said Alisa Ray, executive director and CEO of the Certification Commission for Health Information Technology, of EHR vendors’ readiness for Stage 2 meaningful use. “They’re working hard. They’re struggling a little bit.”

That stands to reason, considering that, when comparing Stage 1 to Stage 2 certification, technology developers are “navigating a higher bar and increased complexity,” she said.

As the end of 2013 closes in, most federal certification bodies are noticing an uptick in the number of vendors who are applying to become certified under the 2014 criteria — the same criteria that will be required for the EHR products providers must use to attest to meaningful use Stage 2.

But not all of them are finding the process to be a cakewalk. Ray said there are three areas of Stage 2 that are proving the most challenging for certification: clinical quality measures, interoperability, and automated measure calculation for reporting metrics.

Automated measure calculation “requires almost a whole day of testing,” she said. “There are just a lot fewer products than were there with the Stage 1 or 2011 criteria.”

CCHIT has close to 40 companies with products listed. “Of the 2011 products we certified, we’ve seen 21 or 22 percent having been completely certified to date,” Ray continued. “It’s a testament to how much harder it is.”

Amit Trivedi, healthcare program manager at ICSA Labs, added that many vendors might also be going through certification fatigue, and explained that in stage 1 there were close to 3,000 listings, and many vendors had multiple entries (Cerner had 800) but for Stage 2, so far there are fewer than 300 on ONC’s Certified Health IT Products List.

And without naming names, Ray said that “almost everyone has struggled and been surprised by the complexities,” and a number of them have had to go through several certification trials, after not meeting certain criteria. “There are companies that have been testing every year since 2006 with the CCHIT programs; it’s not like they’re novices. And when they get into it, there’s a new wrinkle or something they may not have anticipated or configured correctly.”

With mHealth becoming the norm instead of the exception, a panel at Partners HealthCare’s 10th Annual Connected Health Symposium last week concluded that EHR vendors will have to find a way to modify their products to focus on data that the patient and his or her care team want, or they’ll become obsolete.Important information for a patient’s care actually exists outside the electronic medical record, panelists said.

[See also: Object of beauty, or ungainly nuisance?]“In many ways the EHRs are on the outside,” said Andrew Watson, MD, medical director for the Center for Connected Medicine at the University of Pittsburgh Medical Center and the panel’s moderator. “This is on the inside. It’s not the paranormal … any more – it’s the normal.”

The session, one of the first during the two-day summit at the Seaport World Trade Center in Boston, focused on what Watson termed the “para-EHR,” which he defined as all of the phone calls, texts, e-mails and other doctor-doctor and doctor-patient communications that aren’t entered into the EHR. They could include everything from Skype chats between doctors to Post-It notes to data residing on mobile devices and sensors.

Watson, who’s also a colorectal surgeon at UPMC, estimated that 70 percent of his work with patients is conducted in that informal region outside the EHR. His fellow panelists put that number closer to 90 percent.

“The systems that we have today are not geared toward clinical efficiency,” said Rasu Shrestha, MD, UPMC’s vice president of medical information technology, who said EHRs are instead geared toward billing. He called the para-EHR “this other bucket of information” that more closely resembles the doctor-patient encounter.

“Whatever it is today, it’s going to get bigger,” added Kent Gale, founder and chairman of KLAS.

Watson and his colleagues – who also included Eleanor Chye, assistant vice president of AT&T’s ForHealth department, laid the blame for this disconnect squarely on the shoulders of modern technology. The ability to communicate and capture data in real time through mobile devices and wearable sensors, they said, has made the typical EHR obsolete.

“When the digital age collided with healthcare, which I think was around 2007, healthcare stumbled heavily,” Watson said. Shrestha added: ‘We focused on where the money was as we moved from analog to digital.”

Chye said the healthcare industry’s efforts to catch up aren’t having the desired effect. Meaningful use, she said, “has created a big, sucking sound and taken all the air out of the room.”

The true patient record lies in the margins outside the EHR, and contains “data that would save a patient’s life,” Shrestha pointed out. When prodded by Watson, the audience agreed. One person pointed out that there is no place in the EHR for the patient’s story, while another questioned whether the electronic health record should be organized like a Wiki page.

“I don’t think that any single EHR can humanly tackle this,” Watson said.

“I do think there is a burning need to focus back on the PHR,” Shrestha said, pointing out that those records contain all the information important to the patient – and nothing more. ‘You don’t want to be inundated with data back to the point where it’s noise,” he added.

Chye said EHR vendors have to decide whether to build out to capture that data or encourage innovation outside the EHR. In addition, she pointed out, should all of that unfiltered information be given to the patient?

‘If it’s there, it ultimately will be discoverable, and it ultimately will be pursued,” said Gale, who offered that EHRs are currently designed to be provider-centric, rather than patient-centric.

Objectives: To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement.

Methods: The survey was administered by mail with telephone follow-up and had a 61% weighted response rate. The overall sample consisted of 4326 respondents. We calculated estimates of electronic exchange capability at the national and state levels, and applied multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics.

Results: In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries.

Conclusions: In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians’ capability to exchange varies by vendor and by state.

The capability to electronically share and view clinical data has the potential to enable clinical information to follow patients wherever they go to seek care and thereby improve the safety, quality, and efficiency of healthcare.1 Despite promising benefits, historically physicians have not exchanged clinical information electronically due to the high costs associated with implementation and limited incentives for data sharing.2 Exchange activity has largely been confined to regions of the country where there are operational health information organizations that support clinical data exchange within their community.3 Furthermore, physicians have typically had to use stand-alone e-prescribing systems or proprietary portals that support the exchange of specific types of clinical data (eg, viewing lab data), which can be costly, difficult to incorporate into their clinical work flow, and possess limited capability to support integrated data as with an electronic health record (EHR).4-7

A number of federal programs and other initiatives are under way to help address some of these barriers. The Health Information echnology for Economic and Clinical Health (HITECH) Act of 2009 includes up to $22.5 billion in financial incentives for eligible professionals who demonstrate “meaningful use” of interoperable EHRs capable of electronic exchange. HITECH also awarded more than $540 million to the Office of the National Coordinator for Health Information Technology (ONC) State Health Information Exchange (HIE) Program, which provides support for state-designated entities to ensure mechanisms are in place to enable providers to exchange clinical information.8 Furthermore, ONC’s Health Information Technology Certification Program seeks to ensure that EHR products include functionality that enables electronic exchange.9 In addition to the HITECH incentives and programs, a public-private initiative provides relatively simple technical solutions to enable directed exchange between 2 known providers.10 A community of participants from the public and private sector focus on providing tools, services, and guidance to promote functional interoperability.11

In the first stage of meaningful use, it was sufficient for providers to perform a test to demonstrate their EHR’s capacity to electronically exchange information.12,13 Stage 2 meaningful use requirements related to HIE have evolved to become more advanced. Physicians must go beyond demonstrating capability to exchange; they must actually electronically exchange key clinical data among providers and patient-authorized entities. Additionally, physicians must demonstrate the capability to send summary-of-care documents electronically to recipients with a different EHR vendor.14

Yet little is known about current physician capability to electronically exchange clinical information at a national or state level, both of which are relevant in implementing ONC’s strategy and in assessing its potential for success. We used a nationally representative survey of office-based physicians conducted in 2011 to provide a snapshot of physicians’ capability to electronically exchange clinical information associated with key national priorities: pharmacy exchange(e-prescribing), laboratory exchange (including receipt of results and lab orders), and clinical summary exchange with patients and providers.15 This assessment provides both a portrait of exchange capability as of stage 1 meaningful use and a baseline for monitoring progress going forward as new policies and initiatives to accelerate HIE are implemented—in particular, stage 2 meaningful use. Future trends in physicians’ HIE capability could help assess the effectiveness of these policies. We describe physician exchange capability geographically across states and by EHR vendor. Finally, we examined the association between physician and practice characteristics, including adoption of EHRs, with physician capability to exchange different types of clinical information. – See more at: http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n10/physician-capability-to-electronically-exchange-clinical-information-2011/1#sthash.H3s71xpQ.dpuf